Summary & Overview
CPT 85240: Factor VIII Antihemophilic Globulin Clotting Assay
CPT code 85240 denotes a laboratory clotting assay to detect factor VIII antihemophilic globulin (inhibitory antibodies) in a patient’s serum. This test is clinically important for identifying inhibitors that neutralize factor VIII activity, which directly affects diagnosis and management of hemophilia A and other bleeding disorders. Nationally, accurate detection of factor VIII inhibitors influences treatment selection, use of bypassing agents, and monitoring of immune tolerance induction.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content summarizes how the code is categorized, typical clinical context, and operational considerations relevant to laboratories and billing teams.
Readers will learn the clinical purpose of the assay, typical settings where the service is performed, and what to expect in payer coverage discussions. The publication also provides benchmarks and policy context where available, and highlights common billing modifiers and coding considerations for laboratory service lines. Data not available in the input is noted where applicable.
Billing Code Overview
CPT code 85240 describes a laboratory clotting test performed by a laboratory analyst to detect the presence of factor VIII antihemophilic globulin in a patient’s serum. This assay assesses whether antibodies against factor VIII are present, which can interfere with clotting and affect the diagnosis and management of bleeding disorders.
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Service type: Laboratory immunohematology/clotting assay
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Typical site of service: Clinical laboratory or hospital laboratory setting where serum testing and clotting assays are performed.
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Clinical & Coding Specifications
Clinical Context
A 28-year-old male with a history of easy bruising and prolonged bleeding after a dental extraction is referred to hematology for evaluation of suspected hemophilia A or acquired factor VIII inhibitors. A phlebotomist draws blood and the specimen is sent to the laboratory. The clinical laboratory technician performs a clotting assay specifically to detect the presence of factor VIII antihemophilic globulin (factor VIII inhibitor) in the patient’s serum. The workflow includes specimen receipt and accessioning, separation of serum, performance of the clotting test (Bethesda or equivalent inhibitor assay technique), calculation of inhibitor titer, verification by a laboratory director, and reporting of results to the ordering hematologist.
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Service type: Diagnostic coagulation laboratory test for factor VIII inhibitor detection.
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Typical site of service: Hospital laboratory, independent clinical laboratory, or outpatient reference laboratory supporting hematology clinics.
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Typical patient scenario: Patients with unexplained bleeding, prolonged activated partial thromboplastin time (aPTT) not corrected by mixing studies, recurrent hemarthroses, or patients with known hemophilia A who develop a sudden loss of factor VIII efficacy after factor replacement therapy.
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Result use: Confirms presence and estimates titer of factor VIII inhibitors to guide treatment decisions such as immune tolerance induction, bypassing agents, or modification of replacement therapy.